Thursday, September 13, 2007

An interesting midwifery proposition

I was contacted a couple of weeks ago by a man who is looking for a midwife for his African wife. The interesting aspect of this inquiry is that he lives just outside Dar es Salaam, which is the capital city of Tanzania. He is a kiwi who has lived in Tanzania for a few years. He would like a western-trained midwife to attend his wife for a home birth - they have had terrible experiences in the health system there, so are extremely wary of having a baby in a hospital there. He does not want to go to one of the European hospitals in South Africa because he does not know anyone there. So the options for them are: to import a midwife or come back to NZ for the birth. The problem with coming back to NZ is the woman will be away from her family and culture.

He has contacted a number of midwives, but has narrowed them down to me. We have talked on the phone and I am reassured that this is a genuine proposition. There are a number of issues to consider but I just cannot make up my mind what to do. He has offered to fly me there next month to meet them and check them out. Here is a list of pros and cons: I would really appreciate your feedback that will hopefully help me make up my mind.

Pros

1. Expenses will be covered - ticket will be sent to me before hand so I am not stranded in Africa.2. Amazing opportunity to get a taste of Africa; to challenge myself, both on a personal and professional front.3. Give me an opportunity to meet third world health professionals (in my usual manner of not wanting to let any opportunity go past, I would make sure I hooked up with local midwives and maybe offer to do some teaching/research).4. This experience would no doubt lead to some sort of research output even if its a published reflection of what happened.5. They have access to the Internet so I could keep in touch and continue to monitor my PhD research.

Cons

1. In a professional situation where I would have minimal back-up. They do have access to an obstetrician and if the worst came to the worst, would have access to a hospital for emergency treatment. Equipment would not be an issue because they would be able to access it there. Even if I had a really bad day, my care would be 100% better than what would be provided there. Bottom line: I would be the bottom line - do I have the confidence and ability to take on that degree of responsibility without a trusted midwifery colleague there to back me up, which is how I would normally practice here in NZ. It is not as if I would get sued if anything did go wrong, but I obviously have my own professional standards to maintain.2. This would take me away from my PhD for a month. She is due in the middle of March which is when I am supposed to be starting to interview participants about their experience of the e-mentoring. It would not be a matter of life and death if I delayed things by a month but would add a little pressure to my time line.

I'm sure there are more cons but my mind has gone blank at the moment. As I said, all feedback would be very gratefully received so if you would like to add a comment please do so in the box below.

Hi Sarah Very interesting I am like you immediate reaction would be yes i will go - then I would consider the options as you have donemy thoughts are that money doesnt seem to be an objct so if they are offering to fly you out to meet them then at least agree to do thatI thnk you will be in a much better situation then to make up your mind as to whether to take the case on Practical things for me though would includeWill you get leave from workWill you be paid for your services

If you went next month you could do all the things you would do at home when considering a caseYou could look for yourself at the local back up servicesEnsure you at least had access to secondary care services and decent telecomunicationsMeet the family - find out if you can what the terrible health care expereice was -- is it going to impact on birthing and all thatBut from my own experience you will know if it feels rightRe Phd and managing that is there any chance that you could bring the interviews forward a month so you could be transcribing and and analysing - is there any way you could do them from over there or are they face to faceand finally listen to your gut feelings .. I think they are usually right let us know what happens mary

Thanks for that, Mary. I think time off work would probably not be an issue - I would see it as professional development, so would take the appropriate leave. I think my PhD is probably my biggest issue. As for my instincts - this is why I put out this request-I just don't know what my instincts are. This in itself may mean I shouldn't go?

Just a thought Sarah but do you have registration in Tanzania? and if not then what could happen to you if something (God forbid) went wrong? Are you able to access any other midwife/nurse/health professionals who have a similar experience?

You're right, Graeme, about registration being an issue. I am currently looking into that. There is a regulatory body, but I wouldn't imagine that the regulations are that stringent. As for if something goes wrong, that is obviously a huge concern. I guess I would have to do what I always do: make sure my documentation is brilliant; discuss all eventualities with the couple and go through scenarios. I have touched on that with the chap: a death is more readily accepted there because their mortality rates are so much higher, but as I said to him, a death would not be acceptable to me. If regulations are as lax as I think they may, there would be little or no come back for him if something did go wrong - although it is something very much a consideration for me. I do not want to risk my professional reputation.

I do not know another midwife who has had a similar experience, but I am in the throes of contacting midwives in Tanzania.

Just as a matter of interest: I have decided not to pursue this any further. I think I have been using this proposition as an excuse to procrastinate on my PhD, but as a dear colleague said, I need to concentrate on that.

Sarah Stewart

Welcome to my blog which is a mix of talk about stuff that takes my fancy. My views are my own and not necessarily of my employer, the Australian College of Midwives. I am always really interested to hear your thoughts and feedback, so please feel free to leave a comment at any time.